Acute Appendicitis Complications | Appendix Rupture | Appendicular Mass and Abscess

Complications of Acute Appendicitis

Most common complication of acute appendicitis is rupture of inflamed appendix. This can lead to surgical emergency which calls for surgical intervention for the treatment of the same.
Other complications are appendicular mass, abscess and suppurative (pus formation) pylephlebitis.

Appendicular Rupture

  • Use of antibiotics therapy in an attempt to avoid or postpone operation is dangerous and is never advised.
  • In this case if the obstruction persists the pathology will continue to make the appendix gangrenous and will cause rupture of the appendix.
  • Rupture of the appendix takes place distal to the obstruction or rarely at the place of obstruction.
  • Contents of the distended appendix spill through the necrotic rent into the peritoneal cavity. General peritonitis from the ruptured appendix is dangerous.

Appendicular Mass

  • In majority of cases as soon as the appendix becomes gangrenous, coils of small intestine cover the inflamed appendix all around.
  • There is no discrete collection of pus inside. This is an attempt of the nature to prevent general peritonitis even if rupture of the appendix occurs.
  • Usually such appendicular mass develops on the 3rd day after the commencement of attack of acute appendicitis. This is a tender mass on the right iliac fosse.
  • This mass usually resolves by conservative mass may turn into an appendicular abscess and becomes larger in size.

Appendicular Abscess

  1. A progressive suppurative process in an appendicular mass forms an appendicular abscess walled off by the omentum, inflamed caecum and coils of small intestine.
  2. Such abscess may follow the appendix rupture with the expulsion of small content of the appendix distal to the obstruction.
  3. The caecum contents cannot come out due to the occluding faecolith. In such appendicular abscess there may be variable pyrexia (fever) and slight increase in the pulse rate.
  4. There is definite increase of the leucocyte count (white blood cell count).
  5. The most common site of the abscess is in lateral part of the iliac fosse and  next common position is in the pelvis.
  6. In the untreated cases lethal form of peritonitis is produced by secondary rupture of appendicular abscess.

Suppurative Pylephlebitis

  • Ascending septic thrombophlebitis (inflammation of the blood vessels) of the portal venous system (pylephlebitis) is a grave but rare complication of gangrenous appendicitis.
  • Septic clots from involved mesenteric veins produce multiple pyogenic abscesses in the liver. It is heralded by chills, spiking fever, right upper quadrant pain and jaundice.